This project will span throughout 2023. Resources will be needed for specific durational roles within this period with expectation of completion to be defined by the operational and functional level of system stability. Tapestry Platform Implementation: VHP has implemented a new Epic Tapestry platform to consolidate the management of VHP’s key business functions. This application portfolio includes membership and enrollment functions, utilization management / treatment authorizations referrals, case management, population health, and claims / capitation processing and payment operations.
The new Epic Tapestry platform contains a series of portals for external parties to interface and do business with VHP. This includes the MyChart portal for members, Tapestry Link for providers to transact with VHP, and Healthy Planet Link for community providers. Resources assigned to this project will perform duties supporting the stabilization and accuracy of the new Epic system, including:
- Responding to and resolving issues identified by end users.
- Defining, documenting, and executing new or revised workflow build within the system.
- Defining and/or maintaining, documenting, and building integration workflows with external trading partners.
- Testing the accuracy of new or current build efforts.
- Documenting and/or maintaining business and technical requirements.
- Monitoring the accuracy and performance of system workflows. Specific start and end-dates may vary as the stabilization project evolves.
Resources will provide direct Epic application support and Epic software development lifecycle for the design, development, monitoring, testing, updating, integration, and maintenance of system stabilization. Resources will analyze user, system, and application needs and will evaluate approaches to determine the best solution to meet VHP’s business needs via performance of the defined itemization of responsibilities above and below.
- Analyzing of workflows, data collection engines, and reporting details.
- Interviewing end users and stakeholders to create business, functional, and technical requirements documents based on captured data in accordance with departmental protocols/standards.
- Supporting the process of making the best decisions associated with choices offered by Epic.
- Analyzing business operations and investigating end user preferences while making build decisions.
- Recommending process improvements and enhancements for better operational performance and implementing those recommendations within the Epic system.
- Serving as a liaison between end users’ workflow needs and Epic assigned implementation staff.
- Maintaining regular communication with Epic representatives, including participating in weekly project team meetings.
- Working with Epic representatives, your organization’s business community, and end users to ensure the system meets the organization’s business needs regarding the project deliverables and timelines.
- Analyzing, designing, configuring, testing and evaluating new or changed business application functionality and workflows to meet requirements. • Managing master file changes for new features.
- Collaborating with others as needed for Epic native reporting.
- Investigating, designing, developing, testing, and implementing Epic native reports and dashboards.
- Attending/coordinating meetings to perform ongoing reviews of end user issues with workflows and system capabilities.
- Ensuring interoperability between Epic applications and other supporting applications.
- Working to ensure that inbound and outbound data interfaces and transfers are functioning as desired.
- Designing, developing, modifying, and implementing testing processes including scripts, recording of results, and facilitating end-user testing.
- Providing information to instructional designers to facilitate instructional training and participating in training and works with end-users.
- Documenting work time and progress according to department procedures, such as through remote activity logs and build tracking documents.
Qualifications and Success Factors:
Experience: 3+ years of Epic application build and Epic implementation experience at a health plan or health care provider (5+ years preferred) Certification: VHP needs to assemble a team of internal and contractors that will collectively possess the set of certifications for the applications outlined below. Submitted resources should have one or more of the following certifications to be considered.
When submitting candidates, the certification possessed by the candidate should be clearly identified to meet one of the application category sets below:
Category Set Applications Covered Certifications / Supplemental badges and training needed
- Healthy Planet with Epic Care Link Health Planet Analytics and Clinical Build + Epic Care Link
- Healthy Planet Health Planet Analytics and Clinical Build
- Membership + Premium Billing +Data Courier Tapestry Eligibility and Enrollment Administration + Tapestry Premium Billing Administration + Data Courier Mover
- Membership + Benefits Engine Tapestry Eligibility and Enrollment Administration + Benefits Engine
- Membership + MyChart + CRM Tapestry CRM Administration + MYC200
- Medical Management Referrals and Authorizations for Tapestry Organizations
- Medical Management + Plan Link Referrals and Authorizations for Tapestry Organizations + Tap121i
- Claims Administration Tapestry Claims Administration
- Claims / Contracts Tapestry Claims and Contracts Administration
- Accounts Payable Tapestry Accounts Payable Administration
The assigned resources will collectively need the following portfolio of desirable qualifications and success factors:
- Experience in business analysis and project management.
- Knowledge of healthcare and health insurance regulatory standards.
- Epic implementation experience specifically at a health plan.
- Understanding relationships of providers and their processes in the healthcare continuum (primary care, specialists, lab ordering, surgery).
- Familiarity with case management workflows and wellness programs. Familiarity with or background in quality reporting initiatives such as PQRS, ACOs/MSSP, and MU.
- Familiarity with health plan concepts and workflows.
- Understanding of operations within the AP Claims department, including claim intake, review, and payment.
- Familiarity with integration points with other areas of business, such as eligibility, authorizations, and internal claims.
- Familiarity with the benefit structures of plans.
- Familiarity with the use of care plans to coordinate care for members/patients.
- Familiarity with managed care contracting.
- Understanding of treatment authorization polices/processes that affect approvals or denials and the concepts of treatment referrals and the processes followed.
Key Management Competencies:
- Demonstrating flexibility with respect to changing end-user business needs.
- The ability and willingness to see things in an open-minded way and examine an idea or concept from as many angles as possible.
- The ability and willingness to take ownership of work activities and ensure that they are completed in an accurate, efficient, and timely manner.
- The ability and willingness to recognize assignments or tasks that need to be completed, to seek out additional assignments or tasks, and to help others.
- The ability to communicate information clearly and concisely with project leadership and subject matter experts.
- The ability to gain trust and establish effective relationships with Epic counterparts.
- The ability and willingness to learn new software and systems.
- Listening attentively to ensure that the intended message has been accurately received, holding responses until the person has finished making their point, and repeating information to ensure accuracy.
- Seeking, logically examining, and interpreting information from different sources to determine a problem’s cause and developing a course of action to resolve the problem and to prevent its recurrence.
- The ability to persevere in difficult situations, overcome obstacles, and reach high levels of performance when faced with stressful work situations and time pressures.
Contract Term: 12 months Requesting Department: Valley Health Plan On-Site Requirements:
Resources may be required onsite maintaining a standard alternating weekly schedule of Monday – Thursday in office, Friday as a travel day and the following week as fully remote. Fully remote work with occasional travel to onsite may be approved depending on the contracted resources geographical location, travel rates, availability, and necessity. Overall onsite requirements are managed on a per contractor basis and can be subject to change with advanced notice based on departmental necessity.